Provider Demographics
NPI:1568451326
Name:ENDOSCOPY CENTER NORTH
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-872-4555
Mailing Address - Street 1:10600 MONTGOMERY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4463
Mailing Address - Country:US
Mailing Address - Phone:513-872-4555
Mailing Address - Fax:513-872-7625
Practice Address - Street 1:10600 MONTGOMERY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4463
Practice Address - Country:US
Practice Address - Phone:513-872-4555
Practice Address - Fax:513-872-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0621AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2260735Medicaid
OH2260735Medicaid